QCMetrix, Inc. proposes to expand upon the strengths of the National Surgical Quality Improvement Program (NSQIP) to develop, implement, and evaluate a software system, Decision Support for Safer Surgery (DS3). DS3 will inform the care provider of patient-specific risks for surgery and of evidence-based processes of care that will minimize these risks in real- time, and will facilitate the collection of Surgical Care Improvement Project (SCIP) measures. The CMS Surgical Care Improvement Program's (SCIP) performance measures are complex and will need aggressive implementation strategies. The National Surgical Quality Improvement Program (NSQIP) collects surgical data from participating hospitals and reports risk-adjusted surgical outcomes back to the hospital. The rationale for this proposal is to initiate the first steps of taking the NSQIP from retrospective data collection and reporting to real-time data collection and clinical decision support. The goals of DS3 are to assist care providers in improving performance on the SCIP measures and reducing surgical complications. Project Objectives. 1) Develop risk models to assist in patient risk evaluations and review and affirm SCIP processes of care. 2) Implement and integrate a clinical decision support system into the workflow of the care providers. 3) Test DS3 in two hospitals. 4) Measure and address barriers to implementation of decision support in the preoperative setting. 5) Measure the effect of DS3 implementation on concordance with SCIP process measures for the two hospitals. Project Methods. This is a 3-year Fast-Track proposal. In phase 1, a 6-month planning study, we will update the risk models previously constructed for perioperative surgical site infections, myocardial infarction and cardiac arrest, deep vein thrombosis, postoperative pneumonia, and mortality. We will conduct site visits to gather requirements for the DS3 system and we will prepare a planning document for Phase 2. In Phase 2, a 30-month implementation project, we will implement a DS3 prototype, link the system to existing health information systems, and live test the prototype at two hospitals. We will train care providers in the use of the system and will collect usage statistics. We will conduct surveys to document user experience and user opinion and will examine concordance with the SCIP measures before and after the introduction of the system. Benefits. Reducing surgical complications is a national focus. We expect the proposed decision support system to be instrumental in the workflow of surgical care. Patients will benefit from this system because it is focused on the reduction of surgical complications. Care providers will benefit from the system because the evidence-based care process will be made more consistent and efficient. Hospitals will benefit economically because the system is intended to reduce the cost of surgical complications and will meet pay-for-performance criteria.